Patients' expectation and satisfaction with removable dental prosthesis therapy and correlation with patients' evaluation of the dentists

Objective. Considering that patients' satisfaction is one of the most important goals in conducting removable dental prosthesis (RDP) therapy and the fact that there are many factors which influence this parameter, the present study aims to evaluate the expectation before and satisfaction after therapy with RDP in patients who seek such therapy. As a secondary objective, other variables that may be associated with patient satisfaction are also evaluated, such as gender, age, Kennedy's classification of the arch supporting the RDP, the number of RDP adjustments after delivery and patients' evaluation of the dentists' conduct. Materials and methods. A sample of 44 patients who received RDP therapy were assigned visual analog scale scores for their expectation before and satisfaction after therapy regarding chewing, aesthetics, comfort and phonetics. They also completed a questionnaire concerning the dentists' conduct. Results. There was no statistically significant difference among scores concerning different genders, age, number of post-delivery settings and arch involved in the RDP. Regarding patients' evaluation of the dentists' conduct, there was a predominance of positive evaluations, but only different answers to the statement (i.e. 'The dentist I saw thoroughly explained the recommended treatment before it commenced') present statistically significant different scores for chewing (p = 0.040) and phonetics (p = 0.046). Conclusions. The average visual analog scale scores were high for both expectation prior to treatment and satisfaction after treatment; however, the scores for expectations were higher than those for satisfaction. © 2013 Informa Healthcare.

Effect of different disinfectants on the microhardness and roughness of acrylic resins for ocular prosthesis

Background: Ocular prosthesis materials should have specific properties for their indication and durability; therefore, it is important to investigate their physical behaviour when affected by several disinfectants. Objectives: This study evaluated the influence of different disinfecting solutions on the microhardness and surface roughness of acrylic resins for ocular prosthesis. Materials and Methods: Fifty samples simulating ocular prostheses were fabricated with N1 resin and colourless resin and divided (n = 10) according to the disinfectant used: neutral soap, Opti-free, Efferdent, 1% hypochlorite (HYC) and 4% chlorhexidine (CHX). Samples were stored in saline solution at 37°C and disinfected during 120 days. Both microhardness and roughness were investigated before, after 60 days and 120 days of disinfection and storage. Microhardness was measured using a microhardner and the roughness with a roughness device. Results: N1 resin showed lower microhardness when compared with colourless resin (p < 0.05). HYC and CHX groups exhibited the highest change of microhardness and roughness values (p < 0.05). An increase in roughness and reduction in microhardness of ocular acrylic resins were observed after both periods of disinfection and storage (p < 0.05). Conclusion: Both disinfection/storage periods affected the microhardness and roughness values of the samples. © 2012 The Gerodontology Society and John Wiley & Sons A/S.

Stress distribution in implant-supported prosthesis with external and internal implant-abutment connections

Objective. This study aimed to investigate the stress distribution in screwed implant-supported prostheses with different implant-abutment connections by using a photoelastic analysis. Materials and methods. Four photoelastic models were fabricated in PL-2 resin and divided according to the implant-abutment connection (external hexagon (EH) and Morse taper (MT) implants (3.75 × 11.5 mm)) and the number crowns (single and 3-unit piece). Models were positioned in a circular polariscope and 100-N axial and oblique (45) loading were applied in the occlusal surface of the crowns by using a universal testing machine. The stresses were photographically recorded and qualitatively analyzed using software (Adobe Photoshop). Results. Under axial loading, the MT implants exhibited a lower number of fringes for single-unit crowns than EH implants, whereas for a 3-unit piece the MT implants showed a higher number of fringes vs EH implants. The oblique loading increased the number of fringes for all groups. Conclusion. In conclusion, the MT implant-abutment connection reduced the amount of stress in single-unit crowns, for 3-unit piece crowns the amount of stress was lower using an external hexagon connection. The stress pattern was similar for all groups. Oblique loading promoted a higher stress concentration than axial loading. © Informa Healthcare.

Comparison of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible - A computed tomography-based three-dimensional finite element analysis

A finite element analysis was used to compare the effect of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible. Four models of an human mandible were constructed. In the OR (O'ring) group, the mandible was restored with an overdenture retained by four unsplinted implants with O'ring attachment; in the BC (bar-clip) -C and BC groups, the mandibles were restored with overdentures retained by four splinted implants with bar-clip anchor associated or not with two distally placed cantilevers, respectively; in the FD (fixed denture) group, the mandible was restored with a fixed full-arch four-implant-supported prosthesis. Models were supported by the masticatory muscles and temporomandibular joints. A 100-N oblique load was applied on the left first molar. Von Mises (σvM), maximum (σmax) and minimum (σmin) principal stresses (in MPa) analyses were obtained. BC-C group exhibited the highest stress values (σvM=398.8, σmax=580.5 and σmin=-455.2) while FD group showed the lowest one (σvM=128.9, σmax=185.9 and σmin=-172.1). Within overdenture groups, the use of unsplinted implants reduced the stress level in the implant/prosthetic components (59.4% for σvM, 66.2% for σmax and 57.7% for σmin versus BC-C group) and supporting tissues (maximum stress reduction of 72% and 79.5% for σmax, and 15.7% and 85.7% for σmin on the cortical and trabecular bones, respectively). Cortical bone exhibited greater stress concentration than the trabecular bone for all groups. The use of fixed implant dentures and removable dentures retained by unsplinted implants to rehabilitate edentulous mandible reduced the stresses in the periimplant bone tissue, mucosa and implant/prosthetic components. © 2013 Elsevier Ltd.

Tilted and Short Implants Supporting Fixed Prosthesis in an Atrophic Maxilla: A 3D-FEA Biomechanical Evaluation

Purpose: This study compared the biomechanical behavior of tilted long implant and vertical short implants to support fixed prosthesis in an atrophic maxilla. Materials and Methods: The maxilla model was built based on a tomographic image of the patient. Implant models were based on micro-computer tomography imaging of implants. The different configurations considered were M4S, four vertical anterior implants; M4T, two mesial vertical implants and two distal tilted (45°) implants in the anterior region of the maxilla; and M6S, four vertical anterior implants and two vertical posterior implants. Numerical simulation was carried out under bilateral 150N loads applied in the cantilever region in axial (L1) and oblique (45°) (L2) direction. Bone was analyzed using the maximum and minimum principal stress (σmax and σmin), and von Mises stress (σvM) assessments. Implants were analyzed using the σvM. Results: The higher σmax was observed at: M4T, followed by M6S/L1, M6S/L2, M4S/L2, and M4S/L1 and the higher σvM: M4T/L1, M4T/L2 and M4S/L2, M6S/L2, M4S/L1, and M6S/L1. Conclusions: The presence of distal tilted (all-on-four) and distal short implants (all-on-six) resulted in higher stresses in both situations in the maxillary bone in comparison to the presence of vertical implants (all-on-four). © 2013 Wiley Periodicals, Inc.

Rehabilitation of maxillary cleft with hybrid obturator prosthesis

The hybrid obturator prosthesis aims to provide a sense of well-being to the patient, offering improvements in speech, chewing, and swallowing. Thus, the retention and stabilization of the prosthesis become decisive factors for the success of the rehabilitation treatment. The objective of this study was to describe the treatment of a 70-year-old man with a congenital maxillary cleft performed through aesthetic and functional prosthetic rehabilitation with hybrid obturator prosthesis. In this study, the fabricated prosthesis achieved its purpose by providing adequate functional and aesthetic conditions to the patient, promoting the reduction of airspace through the sealing of the oronasal communication, with consequent improvement in the quality of life. Copyright © 2013 by Mutaz B. Habal, MD.

Patient with a Starr-Edwards Prosthesis in the Aortic Position for 40 Years

Herein is reported the case of a patient who presented initially with aortic insufficiency and a fistula between the sinus of Valsalva and right atrium when aged 31 years. Closure of the fistula and replacement of the aortic valve with a Starr-Edwards A-9 caged-ball prosthesis was performed in 1972, since when the valve has survived for 40 years without dysfunction. This is one of the longest follow ups of the Starr-Edwards prosthesis reported, and highlights the possibility of acceptable valve performance over long periods of time.

Eight-Year Follow-Up of a Fixed-Detachable Maxillary Prosthesis Utilizing an Attachment System: Clinical Protocol for Individuals With Skeletal Class III Malocclusions

The aim of this article is to describe a successful clinical protocol for prosthodontic rehabilitation of a patient with a skeletal Class III malocclusion using a fixed-detachable maxillary prosthesis supported by 6 implants and the MK1 attachment system. The patient was followed up for 8 years. A 46-year-old edentulous woman with a skeletal Class III malocclusion expressed dissatisfaction with her old existing maxillary denture from an esthetic point of view and frustration regarding its function. A fixed-detachable maxillary prosthesis using the MK1 attachment system was made. The patient was followed up clinically and radiographically for 8 years. No bone loss, fracture of prosthetic components, or fracture of the prosthesis was detected in that period. A fixed detachable maxillary prosthesis using the MK1 attachment system is a treatment option for patients with Class III malocclusions who opt not to undergo orthognathic surgery.

Implant-retained finger prosthesis with modified retention system

Background: Amputations affect both the physical and the psychological aspects of an individual, causing significant impact on self-esteem. The main causes of finger amputations are work-related accidents with dangerous machinery, road traffic accidents, and animal bites, as well as systemic diseases such as diabetes. This report aims to describe a simple technique for fabrication of implant-retained finger prosthesis with a modified base of the retention system.Case Description and Methods: The O-Ring retention system was used with a modified hexagon-shaped base and a metallic capsule adapted to the acrylic resin to attach the prosthesis to the implant.Findings and Outcomes: The prosthesis was made with silicone, and after osseointegration, it was installed without complications, leading to a patient satisfied with the end result and encouraged to return to social life.

Influence of nanoparticles on color stability, microhardness, and flexural strength of acrylic resins specific for ocular prosthesis

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

BIOMECHANICAL BEHAVIOR OF THE SYSTEM PROSTHESIS/DENTAL IMPLANT: ANALYSIS BY THE PHOTOELASTICITY METHOD

One of the main reasons for the failure in dental implant treatments is the overload, which can cause bone resorption and later, the osseointegration loss in the implant. Therefore, the aim of this study was to analyze the tension generated around dental implants in the rehabilitation of three mandible posterior teeth, varying the connection type, the disposal, and the quantity of implants. The photoelasticity method was used in order to accomplish it. Through photoelasticity, the quantity and localization of the tensions around the implants in the different studied groups were compared (three straight line implants, three offset placement implants, two implants with a mesial cantilever, and two implants with a pontic). The results showed that the tension quantity and disposition around the dental implants of the connection external hexagon and internal hexagon were similar in all groups. In the group where the cantilever was used, an increase of the tension around the implant, adjacent to the cantilever, was observed. From the results it is concluded that the type of connection used in this study did not influence the tension quantity and distribution around the implants; however, the prosthetic configuration with the cantilever use, led to an increase of the tension around the implant, adjacent to the cantilever.

An alternative technique for fabrication of frameworks in an immediate loading implant fixed mandibular prosthesis

The oral rehabilitation of edentulous patients with immediate loading has become a safe procedure with high predictability. The success is related to immediate fabrication of a passive fit framework to attach the implants. Based on these considerations, this case report shows an alternative technique for mandibular rehabilitation using implants immediately loaded, where the framework was fabricated using cylinders with internal reinforcement and precast pieces, electrowelding, and conventional welding providing esthetics and function to the patient in a short period of time.

Positioning magnets on a multiple/sectional maxillofacial prosthesis

Aim: The aim of this report is to describe a quick and simple method of positioning retention magnets when deformed patients are rehabilitated with an oculopalpebral prostheses attached to a maxillary denture/obturator. Background: In patients with deformities requiring complex rehabilitations, the use of magnets is the most efficient means of providing combined prostheses with retention quality and stability. Usually prostheses with magnets are in sections and have a magnet in each section. When the sections are put together properly, the magnets are attracted to each other and retain the sections. Report: An edentulous patient presented for a post-surgical evaluation of a maxillofacial prosthesis used to repair a partial maxillectomy and left orbital exoneration which removed all adjacent tissues leaving an open communication between the oral, nasal, and orbital cavities. The proposed treatment plan included construction of a maxillary complete denture with a palatal obturator and a mandibular complete denture. Magnets were used to attach the oculopalpebral prosthesis to the maxillary denture/obturator. Summary: Use of retention magnets simplify the clinical and laboratorial phase, retains the denture, and makes it stable and comfortable for the patient. This treatment is one successful approach to the restoration of oral function and increases the patient’s quality of life.

Reestablishment of occlusion with prosthesis and composite resin restorations

Here, we present a case report on prosthetic reconstruction of posterior teeth and composite resin restoration of anterior teeth yielding considerable esthetic improvement, reestablishment of disocclusion guides and function.

Finger prosthesis: the art of reconstruction

Hand deformities affect aesthetics function of hand severely compromised and also cause psychological disturbances. This report describes the fabrication of a silicone finger prosthesis for a patient after an accident at work. The finger prosthesis was retained by a vacuum effect on the stump. The silicone material Silastic-MDX 44210 was used to provide function and aesthetics. The finger prosthesis offered psychological, functional and rehabilitative advantages for the patient. Restoring the natural appearance with the prosthesis eliminated the trauma generated by the dysfunction and represented an efficient psychological therapy.