Túlio Eduardo Nogueira

Photoelastic Stress Distribution Produced by Different Retention Systems for a Single‐Implant Mandibular Overdenture

PURPOSE For patients poorly adapted to conventional dentures, the single-implant mandibular overdenture has been proposed as a simplified alternative for the two-implant treatment, together with the use of immediate loading of the implant. The aim of this in vitro study was to compare the photoelastic characteristics of stress transfer around the implant in a single-implant mandibular overdenture using different types of attachments. MATERIALS AND METHODS A photoelastic model of an edentulous mandible with a resilient edentulous ridge and a unique implant located at the symphyseal region was obtained to reproduce a single implant-retained mandibular overdenture. Six 2.0 mm height attachments were selected and inserted in the same photoelastic model in a random order. A universal testing machine was used to induce axial vertical loads of 70 Ncm applied at the central incisor and at the central region of the first right molar without contact on the contralateral side. The photoelastic analysis was performed using a polariscope integrated into the testing machine. Standard separate views were photographed, using only one model per system. A visual qualitative analysis of stress-induced fringes was performed to comparatively rank the different attachment systems. RESULTS All attachments showed a similar tension distribution concentrated in the apical third, and the highest stress concentration was at the apical level. There was a low stress concentration at the coronal third of the implant, with no discernible stress in the first threads of the implants, except for Dalla Bona, which showed low stress at the coronal part of the implant (1 fringe). No identifiable fringes were observed when the load was applied in the molar region, which resulted from the low amount of stress transmitted by the implant for all attachments. CONCLUSION The load transferred to a single mandibular implant was evenly distributed around the implant with low stress concentration, irrespective of the type of retention system.

Factors associated with the quality of life of subjects with facial disfigurement due to surgical treatment of head and neck cancer

Background Facial disfigurement has been considered one of the most challenging consequences of the surgical treatment for head and neck cancer patients, mainly due to the importance of the facial region for the personal identity, body self-image and interpersonal interactions, which might affect negatively the quality of life. The aim of this study was to assess factors associated with the quality of life of subjects with facial disfigurement due to surgical treatment. Material and Methods Clinical data were retrieved from 103 patient’s medical records and quality of life data were collected using the Functional Assessment of Cancer Therapy (FACT-H&N) questionnaire. Moreover, the degree of facial disfigurement was classified by means of a specific ordinal scale. Results Data from the FACT-H&N questionnaire showed that the domain directly related to head and neck symptoms was considered the most impacted, while emotional domain was the least affected. Lower quality of life was associated with sequels in the neck and/or lower third of the face (β=-0.39; p=0.001), a higher level of disfigurement (β=-0.29; p=0.016) and female gender (β=-0.20; p=0.038). Conclusions Disfigurement due to surgical treatment was significantly associated with the functional dimension of the patients, especially in extensive sequels in the cervical and lower regions of the face. Key words:Quality of life, Head and neck cancer, Patient-reported outcomes.

Effectiveness of immediately loaded single-implant mandibular overdentures versus mandibular complete dentures: A 1-year follow-up of a randomized clinical trial

OBJECTIVE This randomized clinical trial (RCT) aimed to assess the 1-year effectiveness of single-implant mandibular overdentures (SIMO) compared to conventional complete dentures (CCD). METHODS In the first phase of the study, participants received new maxillary and mandibular CCDs. Then, they were randomly allocated to one of the study groups (CCD or SIMO). Participants in SIMO group received an external hexagon implant in the mandibular midline, with the immediate connection of an O-Ring/ball attachment. Oral health-related quality of life (OHIP-EDENT) and patient satisfaction in both groups were assessed before allocation and at 6- and 12-month follow-up visits. Both intention-to-treat (ITT) and per-protocol approaches were used for analyses. Statistical analyses were performed using the Wilcoxon Signed Ranks test and the Generalized Estimating Equations. RESULTS Eighty-four participants (CCD n = 42; SIMO n = 42) were included, out of which 70 completed the 12-month follow-up (CCD n = 34; SIMO n = 36). ITT analysis showed no changes for the CCD group in the longitudinal assessment compared to baseline. Participants in SIMO group had a significant improvement in OHIP-EDENT scores and satisfaction with the mandibular denture. No changes for the maxillary denture were observed in either groups. Similar results were found when per-protocol analysis was performed. CONCLUSIONS SIMO treatment resulted in a significant improvement in patient perceived outcomes compared to the CCD. SIMO may be considered as an alternative treatment modality for patients with poorly adapted and/or unstable mandibular dentures (ClinicalTrials.gov NCT03463174). CLINICAL RELEVANCE The immediately loaded single-implant mandibular overdenture markedly improved patient satisfaction and oral health-related quality of life of conventional denture wearers after a 12-month follow-up.

The economic burden of opioid prescription by dentists: A 12-month survey of consumer expenditure in Brazil

OBJECTIVES To describe consumer expenditure on opioids prescribed by dentists in Brazil during a 12-month period. METHODS We surveyed individual dispensed prescriptions of opioids in private pharmacies from October 2012 to September 2013. A descriptive analysis of costs included a calculation of the overall and mean maximum price to consumers. Monetary costs were converted from local currency units (Brazilian Real - BRL) to international dollars using purchasing power parity (PPP) exchanging rates. RESULTS 129,708 prescriptions were retrieved from the database. The overall expenditure on opioids was R

Nitric Oxide Concentration and Other Salivary Changes after Insertion of New Complete Dentures in Edentulous Subjects

4,316,383.46 BRL or

Exploring motivations to seek and undergo prosthodontic care: a cross-sectional study in a Brazilian adult sample

2,721,315.82 (PPP). The mean cost of an individual prescription was R

A qualitative study of the dimensions of patients’ perceptions of facial disfigurement after head and neck cancer surgery

33.27 BRL (

Cost-effectiveness analysis of the single-implant mandibular overdenture versus conventional complete denture: study protocol for a randomized controlled trial

20.98 PPP), ranging from 14.19 to 3,255.60 BRL. Codeine was frequently prescribed (87.2 percent). CONCLUSIONS The expenditure on opioids is a significant cost to Brazilian patients, especially given that the Brazilian Public Health System should dispense these drugs free of charge. Codeine was the most prescribed opioid.

A survey of retracted articles in dentistry

Objective. To assess changes in levels of salivary nitric oxide (NO) after insertion of new complete dentures and its association with clinical and salivary parameters. Methods. Nineteen fully edentulous subjects were included, mean age 64.4. Unstimulated whole saliva was collected before and after insertion of the dentures, at follow-up visits, and after 12 months. The concentration of the final stable NO product (nitrite) was measured by a colorimetric assay based on the Griess reaction. Clinical parameters were assessed during all clinical visits. Results. Functional adaptation to the dentures progressively improved, with no complaints at the long-term follow-up. NO concentration was not influenced by the level of functional adaptation, presence of injuries to the mucosa, salivary flow, and saliva viscosity. Pairwise comparison showed a reduction in NO concentration at the first follow-up compared to baseline values but differences were not statistically significant. Significant differences were observed in NO concentrations at the long-term follow-up when compared to the first (p = 0.024) and second (p = 0.027) visits. Conclusion. NO concentration reduced after denture insertion and returned to baseline levels in the long-term follow-up. This appears to be an autonomic response of the body and provides valuable complementary information for the management of the edentulous patient.

A 2‐year prospective study of single‐implant mandibular overdentures: Patient‐reported outcomes and prosthodontic events

This study explored the influence of individual and social factors regarding intentions and behaviors related to prosthodontic treatment, using the theory of planned behavior (TPB). A cross-sectional study was designed with a sample of 225 individuals with some degree of tooth loss. A questionnaire was used containing factors that would have potential influence on the intentions and behaviors of individuals, as well as clinical and sociodemographic data. Descriptive statistics, internal consistency analysis, chi-square test for trend, and logistic regression were used for data analysis. The TPB components – attitude toward the behavior (ATB), subjective norm (SN), and perceived behavioral control (PBC) – showed good internal consistency (alpha = 0.60–0.78). Intention and behavior were associated with TPB components and the overall scale. Similarly, positive intentions and behaviors were associated with age, upper tooth loss, anterior tooth loss, and higher social status. Multiple logistic regression showed that intention was associated with PBC (OR =1.57; P<0.016), while behavior was associated with tooth loss in both arches (OR =9.3; P<0.001), anterior tooth loss (OR =5.13; P<0.001), higher social status (OR =3.06; P<0.03), and PBC (OR =1.38; P=0.03). The presence of anterior tooth loss was the most relevant factor for prosthodontic treatment demand and utilization, while socioeconomic status and an individual’s perceived ease or difficulty in undergoing treatment played a significant, but secondary, role in behavior toward prosthodontic care.